Surgery for soft tissue sarcoma
Soft tissue sarcomas are rare, so surgery is done by a surgeon who specialises in treating them. The surgeon is part of a multidisciplinary team (MDT).
You may have a lump removed and only find out it is a soft tissue sarcoma after the surgery. In this situation, you will be referred to a sarcoma specialist who is part of an MDT after your initial surgery.
The aim of most sarcoma surgery is to remove all of the tumour. Usually, an operation called a wide local excision is done. This means the surgeon removes the tumour, along with an area (margin) of healthy, cancer-free tissue around it.
After the operation, the pathologist examines the tissue from the margin. If there are cancerous cells in the margin, you may need another operation to remove more tissue. Making sure the margins are clear reduces the risk of the cancer coming back.
It is difficult to give general information about sarcoma surgery, because the type of operation you have will depend on where in your body the sarcoma is. In this information, we explain the types of surgery used for people with a soft tissue sarcoma in different parts of the body.
Some types of surgery for sarcoma are minor and only involve removing a small amount of tissue. Some operations are major and may affect how that area of the body works, or how it looks.
Before surgery, you may be referred to a rehabilitation team. They will help you recover from the operation and keep as much function as possible. If the surgery is very minor, you may not need the help of the rehabilitation team.
Your surgeon and specialist nurse will discuss your operation and rehabilitation with you.
Surgery is usually the main treatment for soft tissue sarcomas in the chest and tummy. The chest and tummy area of the body is called the trunk. The type of surgery you have will depend on the exact position of the tumour. Your surgeon will discuss this with you before the operation.
If the tumour is in the tummy, it can be difficult to remove it and an area of healthy tissue (margin). This is because the tumour may be very close to vital organs.
You may have radiotherapy after an operation to remove a sarcoma in the chest or tummy. This is to try to make sure any remaining cancer cells are destroyed.
It is usually possible to remove a soft tissue sarcoma in an arm or leg without having to remove the whole limb. This is called limb-sparing surgery. It is often done by using a combination of surgery, radiotherapy and occasionally chemotherapy.
Very rarely, the best treatment option is to remove the affected limb (amputation). This may be because:
- the cancer is large
- limb-sparing surgery could affect major blood vessels
- there is a high risk limb-sparing surgery will greatly affect how the arm or leg works
- limb-sparing surgery could cause long-term pain.
After discussing everything with your cancer doctor, and close family or friends, you might choose to have an amputation instead of limb-sparing surgery.
Surgery is one of the main treatments for soft tissue sarcomas in the head and neck area. The type of surgery you have will depend on the exact position and size of the tumour. Your surgeon will discuss this with you before the operation.
It is important that you understand what is going to be removed and how this will affect you after the operation, both in the short-term and long-term.
There may be a risk your speech, swallowing or eating could be affected for a time after surgery. If this may happen, you will meet a speech and language therapist (SLT) or dietitian before and after the operation. Your surgeon will do everything possible to minimise the changes surgery may cause to your appearance, speech and swallowing.
If the operation involves removing tissue that is used for speech and swallowing, or affects your appearance, you may have reconstructive surgery as part of the operation. This is when the surgeon takes tissue from another part of the body, such as the forearm, thigh or chest, and uses it to replace the tissue they take from the head and neck.
We have more information about surgery for a head and neck cancer.
Depending on the size and position of the tumour, the surgeon may have to remove a large area of tissue. This area may include important nerves and blood vessels. You may need to have surgery to reconstruct the area. The reconstruction will be done at the same time as your operation.
The aim of reconstructive surgery is to make the area look and work as naturally as possible. The exact surgery you have will depend on where in your body the sarcoma is and how much tissue the surgeon needs to remove.
If only a small area needs been removed, the surgeon may be able to join the two edges together again. But for larger areas, they may need to use a skin graft or tissue flap.
A skin graft is a very thin layer of skin. The surgeon (often a plastic surgeon) takes a layer of skin from another part of the body (the donor site). Then they put it over the area where they removed the cancer from.
The outer thigh is a common place to take the skin from. But a skin graft for the face is usually taken from behind the ear or the neck area. This is done to try to get a good skin colour match.
After the operation, you normally have a dressing over the area to press the graft down. This helps create a good blood supply from the blood vessels underneath.
Sometimes, plastic surgeons need to use a specialist technique to repair the operation site. They use a slightly thicker layer of skin and tissue than for a skin graft, which includes fat and muscle. This is called a tissue flap. There are several different types:
- A local flap uses tissue from an area close to where the cancer has been removed.
- A pedicle flap uses tissue from an area further away, but close enough to keep the flap connected to its original blood supply.
- A free flap uses tissue that has been completely removed from another part of the body, along with its blood vessels.
The surgeon and specialist nurse will explain your operation to you and answer any questions you have.
Surgery is sometimes used to remove a sarcoma that has spread to other parts of the body or come back after treatment.
An operation is usually only possible if the tumours are small and there are only a few of them. It is mainly done when the sarcoma has spread to the lungs, but may be used for tumours in other parts of the body.
If you need to have this operation, your doctor will talk to you about it.